Sunday, November 27, 2022

Replies Idiopathic Toe Walking

Kevin Matthews

Following are the replies to my earlier post:
  
cool. Excellent example of less is better. Thank you.
As of feedback
1. Sponge Bob looks like he’s next to catching your head;-)
2. Looks like you have only 2 functional surfaces – the very proximal posterior Achilles tendon/distal GC area and plantar surface against the foot. How about cutting out a large window in the rear aspect of it? Leaving it “horse shoe” shaped? Should reduce overall plantar footprint length and facilitate shoe fitting.
     I repied… it may inpede rotational control
     He replied:
Do I see carbon braid written on the wall? 70/25 rigid/flexible? Or run corrugation posterior?

     My thoughts:  I like the thought.  You could make a sweet ultralow-profile “Toe Walker Blocker”

I have believed in the lesser is better theory. The less joints you cross to achieve your desired result the better. Great vid-I appreciate all you have done and shared.
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Thank you for all the open the back kevin. I have treated toe walking with SMOs and a thin rigid carbon plate under them. It has worked well for most of the kids I’ve worked with.
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Do I see carbon braid written on the wall? 70/25 rigid/flexible? Or run corrugation posterior?
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Hi Kevin,
Thanks for your tips and videos regarding insight on design and
protocols for treatment…. I’ve been treating toe walker for years and
have not considered this design.. Very clever! 

However, most of the kids I treat have developed significant GS
contractures. These limitations in DF range often have already led to a
compensated pes planus foot position. How do you restore DF range? Or
do you? Or is this SMO design only indicated for the toe walker that
has full or functional ranges of motion at the ankle…. Whereas your
just addressing the gait pattern?

Also, I noticed your using a pretty large PF stop option. Have you
considered the Snapstop from Otto Bock?  It’s much more streamlined,
cheaper and more adjustable?

Keep up the good work!  I hope you have some time in you schedule to
respond to this email.      I did.
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Kevin-
Great contribution.  A few questions.
Type of material for the posterior bumper? I assume puff.
Thickness of posterior bumper? Looks like half inch.
Any special reliefs for the achilles tendon or posterior aspect of malleolus considering the increase in pf range that you allow and the support coming from an inferior aspect of the tib/fib complex?
I also assume some concavity for the posterior strut to provide strength.
I do not do pediatrics, but this is a fantastic design.  I have a personal friend to whom I will show this video and I know that the pediatric therapists at the rehab hospital will go nuts over it due to the low profile design.  Thanks for clarifying that it is for the idiopathic toe-walkers.  I bet that there are many orthotists who will complain that it doesn’t work because they will forget that small caveat.
Thanks again!

     My response:
Thanks for the kind words.  Now to answers
 
Material for bumper is 1/4″ Puff, 35 durometer.  I believe in contoured fits but allow a little extra clearance for maleoli and otherwise normal mods.  No need for strength.  It’s an annoyance to be avoided.  As long as they walk normally they hardly know it’s there.
 
Hello Kevin,
I certainly have noticed your progression of video on the net, always getting better.  What sort of equipment are you using for your “tube” videos?  How much time are you allowing for actual production of say a 5 minute clip?

     My replyBelieve it or not I just shoot from the hip.  I have no script, I just say what I know.  Doesn’t always work out the greatest, but time is limited.  I like to share what I’ve learned over the centuries, lol.  Thanks for the nice comment, but not much to it.  I use a simple video camera, no production, just my nephew to post and edit if necessary.  Pretty simple stuff.  Kevin
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Kevin,
Thanks for taking the time to do this tape. i’ll definitely try this design on my next toe walker.
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Kevin, Will you c-fab these for us? I’d like to try this on the next case I see.

     My reply   (lol, my font changed and I can’t change it back)
Sure.
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I have two questions: 1. do you have any issues with chaffing on the achilles tendon from the stop? 2.  How do you bill Medicaid which doesn’t recognize the L1907 L-code? Okay, 3 questions: have you fit patients with achilles tightness with this SMO or do you find yourself having to use an AFO?  Thank you very much.

Relpy: 
We get paid in Texas, no chaffing issues that don’t resolve quickly, never a dealbreaker.  We do not use on tight achilles, spasticity, tone or decreased ROM
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Thank you Kevin. Very helpful.

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Thanks for sharing, I will certainly keep it in mind the next time I see an
idiopathic toe-walker.  I really appreciate your sharing.
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Hi Kevin,+++++++++++++++++++++++++++++++

Just a two cent comment, I have used this design for years on a limited basis.  I think the word “invented” might be a little strong for a relatively simple, logical trim line difference.  I would suppose many practitioners have done this in the effort to curtail plantar flexion.  I just called them a plantar flexion cue. I do think it is nice of you to share for those who have not thought about this trimline.

That’s all folks
 
Kevin C. Matthews, CO/LO
Advanced Orthopedic Designs
12315 Judson Rd. #206
San Antonio, Texas 78233
210-657-8100
210-657-8105 fax

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